Something that no one will ever be able to take away from you is your education.

While I don’t practice in the clinic anymore, the education and experience I gained in that role will always influence how I approach training, performance, injury prevention and rehabilitation.

When I say rehabilitation now, I mean primarily my own.

I don’t “rehab” patients anymore, but I admit to having some minor injuries “here and there” through the years, even though I do everything humanly possible to prevent them. It happens.

Because of my background, I am an expert in rehabilitating myself when I need to.

I know exactly how to restore myself to full functional capacity and I know how to do it veryquickly.

I guess that’s one of the perks of having the PT education and being able to put it into practice.

You see, injury-free and pain-free training is a primary long-term training goal for me.

Anyway, let’s talk about the common questions I’ve been asked about.

I’ll start from the top with the burning question everyone wants to know.

Why did I leave?

1-WHY DID I LEAVE PHYSICAL THERAPY? WHY AM I A “FORMER” PT?

This is really the big question, isn’t it?

Why did I leave the field of physical therapy when I actually loved my role as a clinician?

There are a couple of reasons why I left physical therapy.

The #1 reason was – burn out.

I was simply “burned out” in the clinic. I was fried.

In the final months, weeks and days, I was running on empty.

You might be thinking why was I so burned out?

For almost the last 3 years that I spent in the clinic, I was slowly running myself into the ground.

While the clinic was great, it was largely about the numbers (meaning that I was required to treat a certain number of patients each day).

The clinic I worked in was a very high-volume orthopedic sports medicine clinic.

High-volume is the keyword here and I saw a lot of patients during the course of a typical day.

As time wore on, treating so many patients each day eventually lead to burnout as a clinician.

I’ll give you a more specific example of what I mean and the chaos I faced at times.

There were days when I would be doing a new patient evaluation and I’d also have multiple other patients that I was treating at the same time.

Now, keep in mind that a new patient evaluation requires your focus and full attention.

An “eval” is when you see the patient for the first time and do a comprehensive assessment and plan.

Trying to do this while working with potentially several other patients at the same time was tough, as you can probably imagine.

It was hectic and it was stressful.

This article doesn’t do justice to what it was really like in the clinic – you’d have to experience the situation to really understand the insanity.

Honestly, there were situations where it was challenging for me to give the high-quality standard of care that I demanded of myself. I always felt I provided high-quality care, but it was certainly challenging at times under the demands I faced.

That left me frustrated and disenchanted about what I was doing sometimes in the clinic.

It became a “numbers game” and I didn’t like it.

As with the lessons I teach here – quality is so much more important that quantity.

Funny how that rule applies to many things in life.

That’s the big reason why I left physical therapy, I was simply burned out.

This is not to say that this was the only reason, but it was a big one.

2-WHAT DID MY “TYPICAL” DAY LOOK LIKE?

As I just mentioned, the average day for me was treating several patients during the course of an 8 hour workday.

16 to 20 patients per day was about average, sometimes more and sometimes less.

If you’re a clinician, then you know that’s a large number of patients to evaluate and treat on a daily basis.

You also have to factor in the number of new patient evaluations I did, which took much more time and more brain power, of course.

There were days that I had 5 to 6 patients (or more), in addition to my other returning patients. It could get crazy.

This doesn’t tell the whole story though.

There were always times during any given day where it was totally hectic and chaotic due to patient scheduling.

For example, I can remember many times when I was working with two,three, or more patients trying to give them my full attention and keep them moving along in their rehabilitation program.

Then suddenly, I’d hear my name called over the intercom system announcing that my new patient evaluation had just arrived (for your background: this new patient was supposed to be at the clinic some 2 hours earlier and now finally show’s up for their initial evaluation – this was not fun).

Again, a new patient evaluation is critically important because it was my opportunity to assess them as a patient and design a critical plan of care.

I was proud of my ability to provide a thorough patient evaluation and set an appropriate and individualized plan of care.

After all, that’s what make an effective PT – dare I say a great PT.

The “typical day” always kept me thinking and challenging myself to advance and progress treatment algorithms for the benefit of the patient.

Each and every day was dynamic and fluid with new patients and also advancing treatments with my patient caseloads.

Being in the environment I was in, I came to accept what the day had to bring – and then “roll with the punches” as best I could.

One of the best things about the “typical day” was what I just described.

It was fluid and dynamic and always kept me thinking.

Essentially, there was no “typical day” because each day was so different.

3-WHAT ABOUT THE PROFESSION WAS NOT TAUGHT IN SCHOOL THAT YOU HAD TO LEARN ON THE JOB?

This is a very interesting question because my first job out of graduate school, I was basically running an outpatient clinic.

When I graduated PT school, I started out at a small private practice.

A few weeks in, I became “the” primary physical therapist at that clinic.

I had a physical therapy assistant (PTA) and an athletic trainer (ATC) working with me. I did all the “evals” and they helped me carry the load with the treatment plans and follow-ups.

It was great actually and it forced me to get up to speed very quickly.

But, if it hadn’t been for having outstanding mentors prior to this role, there’s no way in hell I could have ever done this (more in a minute).

PT school teaches you the basics.

PT school teaches you how to be a generalist. It really doesn’t prepare you for “real-world” experiences like this.

What really made a huge difference for me was the clinical internships during my 3 year graduate school education – having phenomenal experiences and incredible mentors throughout my internship process.

This was probably the first time that I realized the real significance of having great mentors in my life.

That’s because I never had mentors as an young trainer when I started out. I didn’t have a “guru” coach that I learned form.

But as a PT, I had a few mentors that were exceptional.

I also had a few that were not. The exceptional ones made the difference and made up for the few who were ‘subpar.’

Looking back, I would say that this was the most important thing to prepare me for coming out of school and facing the “real-world” as a practicing physical therapist.

They taught me how to think and critically evaluate, among so many other things.

A mentor can accelerate your learning faster than anything else.

4-WHAT MADE YOU HATE THE JOB AND EVENTUALLY LEAVE? COULD THAT HAVE BEEN PREVENTED?

I never hated the job.

I loved my job for the most part, but it burned me out.

Just like any job, there are good days and “not so good” days.

There were days I dreaded.

There were days that stressed me out and beat me down.

Those were the “not so good” days.

There were also some other things that could drive me a little nuts, as well.

Let’s face it, there were the good patients and there were the bad patients.

I definitely had a few bad patients through the years that I knew were going through physical therapy because they had to, not because they wanted to actually get better.

They were working the system. I won’t go there.

Let’s just say that the less motivated patient had a way of wearing on me.

Now, most of my memories of patients were great.

I had many outstanding and motivated people that I worked with.

There was nothing really that I hated about the job, but like any job there were things that I disliked at times.

I’ve already talked about the stress and the chaos that I was dealing with in the clinic.

Could this have been prevented?

Well, if I had found another clinic to work in that didn’t operate in the high-volume capacity as the one I was working in, maybe that would have helped.

It’s a trade-off though.

The clinic I worked at, while it had some negative things, it was also a state-of-the-art beautiful clinic.

It offered many opportunities to work with a great variety of orthopedic and post-operative patients.

I got to work with high school, college, semi-pro and professional athletes as well as a very diverse caseload of orthopedic conditions from the general population.

Overall, it was a great experience, but it sure wasn’t perfect.

5-WHY DID I DECIDE NOT TO MAINTAIN MY PT LICENSE?

This is a great question and I’m glad that it was asked.

I have NOT maintained my physical therapy license.

This was a mistake.

We cannot go back though.

However, I would certainly have kept my license active if I had a “do-over.”

I have debated this and looked into sitting for the board exam again – although it would be a ton of extra study time that I’m not sure how I’d manage at the moment.

I have not completely ruled out sitting for the boards again to earn my license back, but I would say it’s very unlikely (I say that now, but this could change tomorrow).

Never say never.

I haven’t been able to answer the question – “How would this help me accomplish my goals? How would it allow me to better serve?”

Yes, it would be great to have my license and treat patients again in the clinical setting.

But, how I work with people now is what I had always envisioned as a physical therapist.

What do I mean by that?

When it comes down to it – I am a movement teacher, plain and simple.

I teach people how to move better so that they get stronger and improve performance – as safely as possible.

My goal is to empower people.

I’ve become much more of a movement teacher than I ever was as a practicing clinician, but a big part of that is the acquisition of knowledge through the years and the clarity of my philosophy.

I’ve learned a helluva lot since my days in practice.

One of the most rewarding things I did when I was in the clinic was teach the “Back School Clinic” for small groups.

I taught, I educated, and hopefully, I inspired those who attended to make changes and take control of their rehabilitative process.

I stood up in front of a group every so often and I discussed how to prevent back injuries. This was easy because I’m a back patient myself and I’m passionate about the topic (always will be).

What I’m trying to say is that being a teacher and being a coach is the greatest role that makes a difference in people’s lives.

At the moment, I don’t need my PT license to do that and my background and education will never fade away.

I will always look at things through the eye of a rehab professional. It’s a part of who I have become.

6-WHAT DO I MISS THE MOST?

I miss the great patients that I was fortunate to work with.

I miss “making a difference” in the rehabilitation process on an individual level.

I remember Linda, one of my “post-op” rotator cuff repair patients, who came to see me and couldn’t move her arm after surgery. When she was discharged from therapy with full active range of motion, normalized strength and nearly full return to function, it was rewarding beyond words.

There was Patrick (my “post-op” ACL patient and a football player) who lost range of motion in his knee joint and had his quads completely shut down following surgery. To know that I was a part in his return to sport the following season with full strength, mobility and function was incredibly fulfilling.

ACL rehab, in particular, is a long process and a long road to recovery. You spend quite a bit of time with your patients and get to know them very well.

There was Steve who came to see me with low back pain as a result of a suspected disc herniation and couldn’t move very well. After a few sessions, his pain resolved, he was moving significantly better and he much better understood the importance of body mechanics and positioning, as well as exercise, to prevent injury and restore his function.

Hopefully, I had empowered Steve for the rest of his life.

The interactions and treatment sessions made a difference for these individuals.

Improved strength, improved range of motion and return to function – that is impact and truly making objective and significant improvement in people’s lives.

I could go on, but it’s the individual impact (specific to rehab) that I miss the most.

The impact I have today is different.

Is it better?

It’s different.

CLOSING THOUGHTS

Do I regret leaving PT?

No.

Honestly, I do not.

The education and experience is truly what makes me different as a strength coach and movement teacher.

I will forever use that background, education and knowledge that I worked so hard to acquire.

One thing is certain, there’s a lot I would do differently if I were a clinician today – knowing what I have learned about strength, movement and human performance.

I think about that sometimes and what it would look like if I were still in the clinic.

I don’t think a lot has changed in the field since I left many years ago (the sad truth).

So, I think my approach would be considered very “contrarian” and unconventional from a PT perspective.

Would I recommend a career as a PT?

Yes, I absolutely would – if you’re willing to keep learning, keep growing and challenge the conventional wisdom that seems to put most clinicians on “cruise control” in their roles as physical therapists.

You must always learn, if you really care about what you’re doing.

I don’t care how much of an expert a person is – there is always something to learn and no individual knows it all.

Great coaches keep their ego in check.

The best coaches I know are student first. They are lifelong learners.

Volunteer your time and get in the clinic to see what it’s really like.

Observe.

Ask yourself – “Can I see myself doing this job? What do I love about it? What do I see that I may not like? What could I do different – and better? Am I willing to invest significantly in my education? Will this help me accomplish my professional goals?”

Also, check out different settings (outpatient, inpatient, sports med, neuro, peds) to get different perspectives. You may know the area your interested in (orthopedics, for example), but I do believe it’s valuable to experience the different settings.

Spread the word! Please share this on Facebook, Twitter, or anywhere you’d like.

Scott Iardella, MPT, CSCS is a strength coach, athlete, and former “physio” who’s mission is to bridge the gaps in strength, performance and injury prevention. Learn how to train at a high level of strengthand performance while minimizing (or negating) risk for injury to achieve an unsurpassed level of results. You’ll find free training resources and giveaways at RdellaTraining.com/join.

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14 Comments

Great article , really answered a lot of the key questions and also gave great insight into the future of performance and rehab which is where I see a lot of the athletes going. It will for sure be interesting in the upcoming years.

A few questions:
Where would you start from an education perspective if you were looking to bridge the gap and open your own performance and rehab center? Any courses, areas of study or disciplines you think are essential to really be a success. (I’m sure there’s more than one)

What are some similar routes that you feel you would have been interested in exploring in the field? (athletic trainer etc)

Great article, Very glad you post it Scott, many many thanks!

Scott

Thanks Luis for the great questions.
The advice is simple really, talk to others who are doing what you think you want to do (someone who has “performance” center, for example).
As far as courses or areas of study, Anatomy, Physiology, Biomechanics go a long way and there are TONS of books listed right here on this site that I’d recommend.
And, seminars and workshops, based on where your interests are.
These are are great places to start – or continue to pursue.
-Scott

Scott

Andy Strauss MPT

Great article Scott. Never knew you you left because of burn out. Even though I’m still in the profession, 23 years now, I left the craziness many years ago. So I know exactly what you’re talking about. Been doing Home Care for a while and it can be just as rewarding even though my patient load is of the Medicare age if you know what I mean. Best part about it is I make my own schedule and it’s 1 on 1 time with the patient. It’s great to see all is going well with you and that you have NO regreats.
I did learn one thing from you from our time working together. “Patient Tolerated Rx without incident.”

Scott

Thanks Andy. Haha, man if that’s the only you learned from me, I didn’t do very good job -:))
Not sure if you remember, but those manual neuromuscular techniques we did for shoulder patients, that was some cutting edge stuff that I learn from one my mentors.
I never saw anyone approach the shoulder like that before – and that was a huge lesson/learning for me that I applied in the clinic that we worked.
Anyway…glad all is well on your end buddy and thanks for posting!
Scott

Jonathan Stehlik

Thanks for the thoughtful article. My response to it other than thanks for the insights would be that you have to do whatever it takes to prepare for the test and get your license back. There is always a different setting that is slower paced you can return to, the license opens many doors, and it validates your own capabilities and skills that much more so. And you will never have to go back to an awkward conversation when asked if you are treating, and you invariably bring up that you are no longer licensed.

Scott

Thanks Jonathan.
Well, there’s way more to this story. This wasn’t a recent decision, this was years ago (so sorry if that was misunderstood).
The bottom line is I have literally never had to bring up that I am not a treating clinician. And, I mean never.
I don’t work in a clinical setting and, frankly, not sure how I’d ever manage going back (from a time perspective), so it’s a complete non-issue.
Appreciate your comments though and hope you got value from the article.
Scott

Don Onofre

I have saved this article a long time ago and this is the only time I have got to read it.

We share the common sentiments when it comes to the quality of patient care that we are “supposed’ to deliver inside the clinics. In the Philippines, “that” number game is rather a trend; the more, the merrier as most PTs would call it. Yeah, it is difficult at the same time rewarding. Not having to mention that we are being paid less than what we are supposed to be receiving (case load per day versus the salary).

I admire you for having the courage to turn your back into a profession that have helped molded you as a person. That is not easy. For many, it is the only thing they have. I hope all is going well with you. I hope to meet you someday too to just talk about anything, PT and non-PT. Have a good one, Scott.

P.S. I have shared your article on my personal FB page with a little intro. Thanks.

Scott

Thanks for the comment Don. It was not easy, but I believe things work out for a reason.
As I mentioned though, the background and mindset of a clinician will always be with me.
This really helps in how I approach training.
Thanks for sharing the article! -Scott

Joe

I came across this article at a very ironic time, as I too am looking to transition from PT in the clinical setting to a strength coaching role where I can bridge the gap from formal PT to return to strength training or sport. Any tips as to how to get started and best environment to make this transition happen? (i.e. college strength coach, fitness club strength coach, work independently) Any insight is much appreciated!

Scott

Well, that’s a great question. Look for mentors and role models who are doing what you want to do.
Talk to them and find out what they’re doing. This will help you get clarity an the direction and setting you want.
If you asked me, my advice is to take the “entrepreneurial” approach. No matter what you do, approach it with the
entrepreneurial mindset. Many books I could recommend on that, but if you’re thinking strength coach – I’d highly recommend
“CEO Strength Coach” by Ron McKeefery. Excellent read. This will give you some insights in the strength coach side and also as an entrepreneur.
Hope that helps and keep me posted. -Scott

Stacey R

I am glad I came across this article. I would like to share that I am leaving everything (PT clinical work and license) for other reasons. I just don’t feel the passion behind the profession. I tried so many different settings and the best has been in the hospital at a prestigious institution in a very large city. It will be my 10 year anniversary as a PT and it is time. I have done a lot of soul searching for the past few years and decided that I do want to help people and that I want to feel challenged to do so but more in health data. I am going back to school for information science. Why do I consider not maintaining my license? I dont feel that any of the continuing ed classes ever provided me with valuable information that would revolutionize the industry. Physical therapy is operating the same as it did years ago. Healthcare is what needs to change and I intend to try to help people by making healthcare across our nation better while using data/information to study what needs to be done. Don’t know why I shared this but now I feel relieved I told someone other than my husband how I feel.

Scott

WOW Stacy, thank you for sharing your story here. I would say the only thing to consider is maintaining that PT license (so you don’t have to worry about sitting for the board exam if you ever decide to dip back into the clinic). You never know. Honestly, I still have it in the back of my mind – will I ever sit for the boards again? Who knows.
If I had to do it over, that is the one thing I would have done differently. I would have kept the license active – just in case. I hear what you’re saying about CE and the current state. Glad to hear you have a new direction and also really glad you decided to share this here. I wish you the best as your new chapter begins. -Scott

About Scott Iardella, MPT, CSCS, CISSN

With over 3 decades of unique experiences, Scott has an accomplished background as a coach and "former" physio. Scott's known as an unconventional strength coach, movement teacher, and performance specialist who gets results. Frustrated by the mainstream, you could say he's very passionate about doing what's right in the area of strength and performance training. Recognized for engineering powerful, no nonsense training programs that increase strength, build muscle, and enhance athleticism while taking a long-term approach to health, fitness, and athletic performance. A true professional who’s dedicated to helping people fulfill their potential through a foundation of strength and better human movement.
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